Appendix D How to Use PostalEASE to Manage Your FEHB Enrollment The PostalEASE telephone system and web sites provide a convenient, confidential, and secure way for you to newly enroll, change your current enrollment, or cancel your enrollment in the Federal Employees Health Benefits (FEHB) Program. If you have access to PostalEASE on the Internet (https://liteblue.usps.gov), at an Employee Self-Service Kiosk (available in some facilities), or on the Postal Service Intranet (from the Blue page), using either of these may be easier than using the telephone.
Through PostalEASE you may: • Make a change to your current enrollment during FEHB Open Season (November 11, 2013 – December 10, 2013, 5 p.m. Central Time) • Make an election as a new employee within 60 days of your date of hire. • Update your dependents’ information — although if you are not making a change in your enrollment at the same time, you must also contact your health plan carrier directly with this information. PostalEASE will not transmit dependent change information to the insurance carrier if an enrollment transaction has not occurred.
Qualifying Life Event (QLE): You cannot use PostalEASE to newly enroll or change your enrollment due to the occurrence of a permitting event, nor to cancel or reduce your coverage due to a qualifying life event (QLE). You must contact the Human Resources Shared Service Center (HRSSC) to assist you with these actions. If you are not making any changes to your current FEHB enrollment, then you do not need to do anything.
Preparing for PostalEASE FEHB Enrollment 1. Read the Privacy Act Statement on page 5. 2. Read and understand the appropriate Guide to Benefits – RI 70-2 for Postal Police and Non-Bargaining Management career USPS employees, RI 70-2A for APWU, NALC, NPMHU and NRLCA career USPS employees, RI 70-2IN for career U.S. Postal Inspectors, Office of the Inspector General and PCES employees, RI 70-2IT for IT/ASC career employees, RI 70-2NU for career USPS Nurse employees, RI 70-8PS for certain temporary (noncareer) USPS employees - mailed to you for FEHB Open Season. 3. Have the following information ready before using PostalEASE. a. Your USPS personal identification number (PIN). If you don’t know your PIN, just call the Employee Service Line at 1877-477-3273. When prompted to enter your PIN, pause and you will be given the option of having it mailed to your address of record. Usually it will be mailed by the next business day. Or, request your USPS PIN from PostalEASE on the Internet (https://liteblue.usps.gov), at an Employee Self-Service Kiosk (available in some facilities), or on the Intranet (from the Blue Page). b. Your Employee ID, which is printed at the top of your earnings statement. Enter all 8 digits, even if the first one is a zero. c. Your daytime phone number. d. The name of the health benefits plan in which you are enrolling. e. The enrollment code of the health benefits plan in which you are enrolling. For the name and enrollment code, refer to your Guide to Benefits, or to the health plan brochure. f. The names, Social Security Numbers, addresses, dates of birth, e-mail addresses and telephone numbers for all eligible family members that will be covered under your health benefits enrollment. You will also need telephone numbers, email and mailing addresses for eligible family members who don’t live with you. For more information on family member eligibility, see your Guide to Benefits. g. The name and policy number of any other group insurance you or any of your eligible family members may have (including TRICARE, Medicare, etc.). h. If you are changing plans or canceling coverage, the enrollment code of the health benefits plan in which you are currently enrolled — that is, the plan that you will not have after your choice takes effect. The enrollment code for your current plan is found on your biweekly earnings statement. It is the three-character code that follows the letters “HP” or “HT.” For example, the Blue Cross Self and Family Standard plan will be shown as HP105SLF or HT105FAM, and you will enter the code 105 in PostalEASE. You may also refer to your Guide to Benefits. 4. Complete the worksheet on the following pages, using the information you prepared above. November 2013 - USPS-24
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Appendix D How to Use PostalEASE to Manage Your FEHB Enrollment
Now You Are Ready To Enroll • If you have access to the PostalEASE Employee Web on the Internet (https://liteblue.usps.gov), at an Employee SelfService Kiosk (available in some facilities), or on the Postal Service Intranet (from the Blue page), using these may be simpler than using the telephone. Just follow the instructions. • Otherwise, call the Employee Service Line to reach PostalEASE toll-free at 1-877-4PS-EASE (1-877-477-3273, option 1) or 1-866-260-7507 for TTY. • When prompted, select Federal Employees Health Benefits. • Follow the script and prompts to enter your Employee ID, your USPS PIN, and information from your completed PostalEASE FEHB Worksheet.
After Completing Your Entries You Should Note the Following Information • Record the confirmation number you receive from PostalEASE: • Your enrollment will be processed on this date: • Your enrollment will be reflected in your paycheck that is dated: It is recommended that you keep this information and your PostalEASE FEHB Worksheet. You may contact the Human Resources Shared Service Center (HRSSC) for assistance if: • you are deaf or hard of hearing, or • you cannot use the telephone, Internet, Employee Self Service kiosk or Intranet for a medical reason, or • you receive a message in PostalEASE directing you to contact the HRSSC when attempting to make a change. Just call the Employee Service Line at 1-877-477-3273. When prompted, select 5 for the HRSSC. Then select Benefits to speak with a representative who will assist you. To reach the HRSSC using TTY, call 1-866-260-7507. Leave your name and email address or phone number where you can be reached along with a message indicating your call is regarding a PostalEASE related issue. If you currently have an FEHB enrollment and you do not want to make any changes . . . do nothing. Dual enrollment is when you or an eligible family member under your Self and Family enrollment are covered under more than one FEHB enrollment. No enrollee or family member may receive benefits under more than one FEHB enrollment. If you or a family member receives benefits under more than one plan, it is considered fraud and your are subject to disciplinary action. WARNING: Any intentionally false statement in this application or willful misrepresentation relative thereto is a violation of the law punishable by a fine of not more than $10,000 or imprisonment of not more than 5 years, or both. (18 U.S.C. 1001)
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PostalEASE FEHB Worksheet Changes due to a qualifying life event (QLE) cannot be made via PostalEASE This worksheet will help you prepare to call PostalEASE, or use PostalEASE on the Internet (https://liteblue.usps.gov), on an Employee Self-Service Kiosk (now available in some facilities) or on the Postal Service Intranet (from the Blue page). You may contact the Human Resources Shared Service Center (HRSSC) by calling 1-877-477-3273, Option 5 or TTY, 1-866-260-7507 for assistance if: • you are deaf or hard of hearing or • you cannot use the telephone, Internet, Employee Self Service kiosk or Intranet for a medical reason or • you receive a message in PostalEASE directing you to contact the HRSSC when attempting to make a change. Please Note: • If you wish to make any change that is not listed under “Type of Action You Are Requesting” below, you must submit your paperwork to the HRSSC. You will need to provide documentation showing that your election is due to a QLE and that you are contacting the HRSSC within the required time frame. For more information on QLEs, please refer to the appropriate Guide to Benefits mailed to you for FEHB Open Season: • RI 70-2 for Postal Police and Non-Bargaining Management career USPS employees • RI 70-2A for APWU, NALC, NPMHU and NRLCA career employees • RI 70-2IN for career U.S. Postal Inspectors, Office of the Inspector General, and PCES employees • RI 70-2IT for IT/ASC career employees, • RI 70-2NU for career USPS Nurse employees • RI 70-8PS for certain temporary (noncareer) USPS employees. Except for open season and the adding of new family members, most enrollments and changes of enrollment are effective on the first day of the pay period after receipt of this form at the HRSSC. The HRSSC can give you the specific date on which your enrollment or enrollment change will take effect.
Part 1 – Employee Information Your Name (Last, First, Middle Initial)
Employee ID
Part 2 – Type Of Action You Are Requesting 1) Open Season: 2) New Hire:
❑ New Enrollment ❑ New Enrollment
❑ Change Current Enrollment ❑ Waive Enrollment
❑ Cancel Enrollment
Part 3 – QLE Actions
3) Special Enrollment
❑ Change Current Enrollment
❑ Cancel Enrollment
(if you are notified that your current plan is being discontinued or your service area is reduced)
(if you are notified that your current plan is being discontinued or your service area is reduced)
(Supporting Documentaton Needed) Marriage: ______________________ Divorce: _______________________ Birth of Child: __________________ Dependent Death: ______________ Other:_________________________
Update Dependent List
Part 4 – Enrollment Name And Code
1) New Plan Name: 3) Old Plan Enrollment Code (if you are changing plans or canceling your current plan)
(Date) (Date) (Date) (Date) (Date)
❑ Yes ❑ No
2) New Enrollment Code:
Part 5 – Your Other Group Insurance (Not used for waiving enrollment as a new employee). 1) Are you covered by insurance other than Medicare?
❑ Yes ❑ No
2) Identify Type of Other Insurance Coverage
❑ Medicare Part A ❑ Medicare Part B ❑ Medicare Part D ❑ TRICARE ❑ OTHER____________________________________________ Other Insurance Policy No.____________________________
If Yes, indicate type of other insurance in item 2.
❑ FEHB An FEHB Self & Family enrollment covers all eligible family members. No person may be covered under more than one FEHB enrollment.
Part 6 – Personal Information Your Gender:
❑ Male ❑ Female
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Married:
❑ Yes ❑ No
Daytime Telephone Number (including area code)
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PostalEASE FEHB Worksheet Employee Name: ________________________________________________________ EIN:__________________________________
Part 7 – Dependent Information (for Self and Family coverage only) A complete mailing address (if different from the USPS employee’s) and other insurance information, if any, must be provided for each covered dependent. If you are adding or updating information for a dependent who does not reside with you, you will need to use the PostalEASE Employee Web on the Internet (https://liteblue.usps.gov), an Employee Self-Service Kiosk (available in some facilities) or on the Postal Service Intranet (Blue page) or contact the HRSSC to process your FEHB enrollment or change.
* Relationship Codes: 01 = Spouse 19 = Child Under Age 26 09 = Adopted Child Under Age 26
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10 = Foster Child Under Age 26 (Requires Certification to be Filed With the HRSSC) 17 = Stepchild Under Age 26 99 = Child Age 26 or Older Incapable of Self-Support (Requires Certification to be Filed With the HRSSC)
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PostalEASE FEHB Worksheet Part 8 Employee Signature _____________________________________________________ Date ____________________________________ Email Address_________________________________________________________ Preferred telephone number__________________
For HRSSC Use Only REMARKS: Specific information on type of qualifying life event, reason for correction, type of certification, supporting documentation, reason for verification, etc., should be provided here. Processing NOTES:
Employing Office: Address: City/State/Zip: PROCESSED BY: Date Scanned To Eagan:
HRSSC COMP & BENEFITS PO BOX 970400 GREENSBORO NC 27497-0400 PPS @ HRSSC
LATE / UNPROCESSED ACTION? DATE RECEIVED at HRSSC: QLE DATE: EFFECTIVE DATE:
❑ Yes ❑ No
File copy in OPF for any FEHB transaction processed by HRSSC and ASC
Privacy Act Statement: Your information will be used to process your enrollment in the Federal Employees Health Benefits system and to manage your claim under that plan. Collection is authorized by 39 U.S.C. 401, 409, 410, 1001, 1003, 1004,1005, and 1206 and 1206; and 29 U.S, 2601 et seq. Providing the information is voluntary, but if not provided, we may not process your request. We may disclose your information as follows: in relevant legal proceedings; to law enforcement when the U.S. Postal Service (USPS) or requesting agency becomes aware of a violation of law; to a congressional office at your request; to entities or individuals under contract with USPS; to entities authorized to perform audits: to labor organizations as required by law; to federal, state, local or foreign government agencies regarding personnel matters; to the Equal Employment Opportunity Commission; to the Merit Systems Protection Board or Office of Special Counsel; the Selective Service System, records pertaining to supervisors and postmasters may be disclosed to supervisory and other managerial organizations recognized by USPS; and to financial entities regarding financial transaction issues. OPM Privacy Act and Paperwork Reduction Act Notice: The information you provide on this form is needed to document your enrollment in the Federal Employees Health Benefits Program (FEHB) under Chapter 89, title 5, U.S. Code. This information will be shared with the health insurance carrier you select so that it may (1) identify your enrollment in the plan, (2) verify your and/or your family's eligibility for payment of a claim for health benefits services or supplies, and (3) coordinate payment of claims with other carriers with whom you might also make a claim for payment of benefits. This information may be disclosed to other Federal agencies or Congressional offices which may have a need to know it in connection with your application for a job, license, grant, or other benefit. May also be shared and is subject to verification, via paper, electronic media, or through the use of computer matching programs, with national, state, local, or other charitable or social security administrative agencies to determine and issue benefits under their programs or to obtain information necessary for determination or continuation of benefits under this program. In addition, to the extent this information indicates a possible violation of civil or criminal law, it may be shared and verified, as noted above, with an appropriate Federal, state, or local law enforcement agency. While the law does not require you to supply all the information requested on this form, doing so will assist in the prompt processing of your enrollment. We request that you provide your Social Security Number so that it may be used as your individual identifier in the FEHB Program. Executive Order 9397 (November 22, 1943) allows Federal agencies to use the Social Security Number as an individual identifier to distinguish between people with the same or similar names. Failure to furnish the requested information may result in the U.S. Office of Personnel Management's (OPM) inability to ensure the prompt payment of your and/or your family's claims for health benefits services or supplies. Agencies other than the OPM may have further routine uses for disclosure of information from the records system in which they file copies of this form. If this is the case, they should provide you with any such uses which are applicable at the time they ask you to complete this form. Public Burden Statement: We think this form takes an average of 30 minutes to complete, including the time for reviewing instructions, getting the needed data, and reviewing the completed form. Send comments regarding our time estimate or any other aspect of this form, including suggestions for reducing completion time, to the Office of Personnel Management, OPM Forms Officer, (3206-0160), Washington, D.C. 20415-7900. The OMS number 3206-0160 is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.
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